| NPI | 1639598519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME143626) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 103167) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2026-07-25 |